Sher-e-Bangla Hospital: ICU needs ATTENTION

The shortage of trained manpower at intensive care units (ICUs) compromises proper treatment of Covid-19 patients, among others, at Sher-e-Bangla Medical College Hospital (SBMCH) in Barishal. 

In March, 150 regular beds and 18 ICU beds for Covid-19 patients were added to SBMCH, the only institution in Barishal division with ICU facilities.

Previously, the hospital had 1,000 regular and 10 ICU beds.

Doctors also say the lack of necessary life-saving equipment is also making the fight against the coronavirus pandemic harder.

From March to June 13, a total of 954 patients were admitted at the coronavirus unit; 453 were released. A total of 52 patients have died; of them 17 were Covid-19 positive and the rest had coronavirus-like symptoms.

According to SBMCH Director Bakir Hossain, a 10-bed ICU needs at least one professor, two associate professors, three assistant professors, four consultants, 10 medical officers and 30 nurses.

But SBMCH only has one assistant professor, six medical officers and 16 nurses for its ICUs with a total of 28 beds, he said.

Only 96 of the 224 posts for doctors in the hospital are filled. Out of the hospital's 19 departments, only one has a department head. Besides, there are only five technologists for sample collection, he added.

"The situation is getting worse day by day as some of the physicians, nurses and technologists are in quarantine. We need doctors, nurses and technologists who have expertise in ICU management," said the director.

Assistant Professor Nazmul Alam of the department of anesthesia, who is also the in-charge of the ICUs, said, "Only I have a six-month training on ICU management here. To operate the critical medical functions of an ICU, trained medical persons are needed. But we could not find anyone else."

While Nazmul and six medical officers are providing service for the ICU beds in the coronavirus isolation unit, an assistant professor is currently looking after the 10-bed ICU for non-Covid-19 patients.

"Since there is no ICU specialist, I have to do the duties of the ICUs as well as those in the operation theatre. I cannot even go into quarantine," said Nazmul.

A patient's relative, wishing anonymity, said mostly junior and untrained doctors remain on duty at the ICUs.

"If a patient's condition deteriorates, the junior doctors do not want to do anything and place a video call to the in-charge for instructions. This way a lot of time is wasted," said the relative.

Meanwhile, the poor functioning of the ICU facilities at SBMCH is reportedly forcing many in Barishal to seek treatment elsewhere.

Anwar Hossain, founder of Barishal's Rahat Anowar Hospital, was flown to Dhaka on June 8 with coronavirus-like symptoms. Hospitals with empty ICU beds were not instantly available there, and on June 9, he passed away.

Laskar Nurul Haque, legal advisor  of Rahat Anowar Hospital, said, "If the ICUs of SBMCH were functioning properly, we might not have needed to go to Dhaka and our patient could have been saved."

Prof Moniruzzaman Shaheen, assistant director of SBMCH and in-charge of the coronavirus unit, said sometimes they were unable to provide critical patients with oxygen support due to lack of high-flow nasal cannula (HFNC).

Besides, HFNC, plasma separator machines, and more ventilators are needed for saving lives, said doctors of SBMCH.

"We are appealing to the rich to donate life-saving medical equipment, such as high-flow nasal cannula system for oxygen delivery and breathing masks, to the hospital," said Sudip Haldar, president of Indoor Doctors Association, a SBMCH doctors' forum.

He said a critical patient is first sedated before putting into a ventilator. Sometimes, the procedure turns dangerous and deadly.

In such cases, high-flow nasal cannula (HFNC) oxygen therapy gives much better results.

Many rich people can afford the cost of one HFNC system which is around Tk 3 to Tk 4 lakh, the physician added.

Asit Bhushan Das, principal of Barishal Sher e-Bangla Medical College, said, "We sent a letter to the Department of Health Services and the secretary of the health ministry to solve the problem."

However, he feels donation of medical equipment to the hospital will improve the situation quickly.

On Monday, civil society members along with Bangladesh Samajtrantik Dal from a human-chain demanded enhancement of ICU facilities to 100 beds and appointment of more trained manpower at SBMCH.